The American College of Physicians has released a new clinical guideline on the treatment of depression in the Annals of Internal Medicine. They suggested that psychotherapy is as effective for treating depression as antidepressants, and “given its relative lack of potential harms, should be strongly considered as the first-line treatment.” This is consistent with the American Psychiatric Association guidelines on major depressive disorder from 2010, which show therapy and antidepressant medications as being similarly effective.

The two issues that I, personally, have with this are: 1) that the guidelines specifically mention CBT and do not adequately discuss the benefits of other modalities of psychotherapy which may lead health care providers and patients to assume that CBT is the only mode of treatment that is so effective, and 2) the suggestion that psychotherapy has a “relative lack of potential harms.” The word “relative” is key here: psychotherapy has significant fewer potential side effects than medication, but this does not mean that psychotherapy is side effect-free. Therapy can be difficult for many patients at different times along the course of treatment and patients should be aware of this from the outset.

In the midst of a traumatic life event, our bodies have a knack of taking over; adrenaline pumps around the body and our natural survival instinct kicks in. But in the aftermath of such an event when the body’s defenses have come down again, we can begin to feel the effects elsewhere – this is known as trauma.

Trauma is categorized as an emotional, physical or psychological response to an extremely negative or stressful event, particularly if it was unexpected, repetitive or if you were in a vulnerable position and felt unable to stop it happening. Childhood abuse can be one major cause of trauma in later life, as can witnessing violence, losing a loved one or being caught up in a disaster or accident.

Trauma can manifest itself emotionally in several, often conflicting, ways. Some people may feel full of uncontrollable anger while others experience a numbness or disconnection that doesn’t allow them to feel anything. Some people may become withdrawn, feeling as if they are in constant danger while others may become reckless with their personal safety.

The short term effects of trauma can often be physical and may include paleness, a racing heart, aches and pains, fatigue or agitation. Long term effects are usually more psychological and can veer into the realms of anxiety and depression if the sufferer doesn’t seek out treatment. Flashbacks, night terrors, difficulty expressing emotion and problems developing relationships can all link back to one traumatic event so it really is important to get professional help as well as self caring in order to overcome this debilitating condition and live a fulfilling life.

Thankfully there are many ways that in which recovery from trauma is possible. There are a number of therapy options when it comes to battling the effects of trauma. Many have different approaches but all focus on restoring the sense of personal safety within an individual. Medication can also be used to help alleviate the symptoms associated with trauma such as anxiety and depression but they do carry risks such as overdose and addiction so this should always be discussed with a healthcare professional. Self care in the form of a healthy lifestyle and a good support network is also important when overcoming trauma. Take action and do not let one event rule the rest of your life.

This post was guest-written by Melissa Davis. For more information please visit Psychguides.

I stumbled upon this brief piece in the Huffington Post about when patients should consider doing psychotherapy, trying medication, doing both at the same time or not doing anything at all. I liked this article because it was short and to the point while giving some nice examples behind the answer to the question: “it depends.”

As a psychologist I have many patients ask for medications and I have many patients refuse my suggestion that they consider medications. I work with only a handful of psychiatrists who I trust, and one of the things that I really like about them is that they don’t always prescribe medication on the first visit and sometimes they don’t prescribe at all. Now days many psychiatrists have defaulted to the role of “prescription mill” and they just see patients on the quarter hour, back to back, writing scripts as quickly as they can. I feel fortunate that I have good relationships with some very thoughtful and knowledgeable psychiatrists.

I also feel fortunate that as a psychologist I have the luxury of time to get to really know my patients, develop a strong therapeutic relationship with them and then help them improve various aspects of their lives. One of my favorite things to do in therapy is to review my clinical notes with a patient when we’re close to terminating treatment. I have found that when people are feeling better they often forget just how bad things were when they first came to me. When we read through the chart together they are reminded of the incredible progress they made.

I often hear from my patients how busy they, their careers and their lives are. Occasionally, their impatient, abrupt or frankly disruptive behaviors at home or at work are blamed upon simply not having the time to slow down to deal with others more gently or explain things more patiently. In their haste they find themselves bogged down by having to deal with others’ hurt feelings, confusion or seeming incompetence; this, of course, only makes matters worse as they then have to apologize, remediate the situation or reexplain things, all in the context of the limited resource of time.

On the way into work this morning, I heard a great piece on NPR about “scarcity.” The piece compared how poor people often mismanage money (e.g., buying lottery tickets, renting large tv’s, etc) to how busy people often mismanage time. Both groups of people have trouble managing their limited resource. I found this fascinating and directly relevant to many of my patients. I do a lot of psychotherapy and remedial coaching with physicians, other healthcare professionals and executives, and I find that nearly all of them are truly quite busy and they work very demanding schedules. But it never ceases to amaze me how so many of these brilliant people struggle to appreciate the need to devote time to their interactions with other people. I’m not a huge fan of Steve Covey’s “7 Habits” but I love the one where he says, “with people, fast is slow and slow is fast.” You can’t rush relationships. You can’t speed up communications beyond a certain threshold. Instead we need to devote sufficient time to our interpersonal relationships, to nurturing them and communicating effectively within them.

My friend and colleague, Mike Plaut, has another paper out (actually it’s still in press) in the Journal of Health Care Law and Policy. Mike’s writing is great – almost conversational – so I always enjoy reading his stuff. In this paper he describes the work he’s been doing for years at the University of Maryland’s Medical School with health care professionals who act out sexually with patients. Similar to the work I do with disruptive professionals, Mike works individually with physicians and other providers rather than working with groups, and he tailors his interventions to the individual. Now, in contrast to most of my work, Mike holds tighter to the role of the academic advisor than therapist or even coach, as he guides the professional through the relevant literature and has them write a paper about the reason for their referral to him. I typically blur the boundary between coach and therapist as I believe there are more similarities between remedial coaching and psychotherapy than differences, and I have found this to be an invaluable approach to my work with physicians, psychologists, nurses, other healthcare providers and other professionals who have gotten themselves into hot water at work, usually because of interpersonal problems.

Look around the room and you’re likely to find at least one person who is on an antidepressant medication now. I just did a Google search for the “top prescription drugs” and according to Drugs.com, one antidepressant and another psychiatric medication are in the top ten ranking. I often perform this search with my patients and there have been times when three or even four of the top ten prescribed drugs have been antidepressants and antianxiety medications.

In a recent piece in The Daily Telegraph from the UK, a general practitioner spoke out about the overuse of such medications, often without adequate discussion about the potential side effects of these drugs. I couldn’t agree more. Now with that said, I should be clear: I often recommend (sometimes quite strongly) that some of my patients consider taking antidepressant and other psychiatric medications. We should not be polarized in our thinking about such treatment… these meds are often quite effective and when properly prescribed can have limited side effects (or we can even “leverage” the side effects to our advantage by prescribing antidepressants that have a more sedating side effect profile to patients with insomnia or meds with a more activating side effect profile to folks having trouble getting out of bed in the morning). But such medications should not be used instead of other treatments such as psychotherapy; they are typically most effective when used in conjunction with talk therapy. For more information see some of my other blog posts such as APA Promotes Psychotherapy and Use of Antidepressants.

I launched PikesvillePsychologist.com at the start of 2011. I hope this site and the blog will prove to be useful and user-friendly. I intend to post regular (but probably not all that frequent) summaries of articles about psychology and psychotherapy as well as some of the specialty work I do with disruptive professionals, most of which are in the medical/health care field. Over time I will most likely convert my first website, HeittC3.com, to be primarily about the consultative work I do with attorneys, hospitals, licensing boards, corporations and other organizations.

I welcome (and in fact would greatly appreciate) feedback about how you have experienced this site, how you found your way to it, and how you think I might be able to improve it.

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I bring decades of experience working in a variety of settings and with a variety of people to my clinical practice. In addition to doing therapy with couples and individuals, I specialize in helping people like you deal with work-related problems.